| pubmed-article:2007443 | pubmed:otherAbstract | PIP: In spite of the successful results of fetal reduction, the author's express concern that the practice not become a part of reproduction management, but as a practice to help infertile couples and prevent the unwanted effects of multiple pregnancies. Since 1977 there has been the ability to promote fertility through use of drugs such as clomiphene citrate and personal and in vitro fertilization with the consequence in multiple embryos. The risks to the mother may be pre-eclampsia, post partum hemorrhage, and thrombophlebitis, and/or fetal pre-maturity, immaturity, and perinatal morbidity and mortality. SInce 1986 fetal reduction techniques have been available. This imposes ethical difficulties. The authors report the results of 22 Belgian patients, who carried 87 fetuses between 1985 and 1989, and received multiple pregnancy reduction (MPR). Of these, 4 are still pregnant at 32 weeks, 4 were lost completely and 1 lost in utero, and 33 live births. The live birth rate was 82% with mild morbidity. 78% were low birth weights including 2 under 1000 grams, but with no losses. It appears from the available evidence that the 15% lost is comparable. The procedure, which is described, was changes from transcervical aspiration to intra thoracic KC1 (potassium chloride) injection due to concern for vaginal bacterial growth, and the safe affects on the remaining fetuses. Complication during pregnancy included three patients with pre- eclampsia, but delivered successfully, and 1 with a Shirodkar cerclage at 20 weeks and with ruptured membranes at 37 weeks, but delivered successfully, and 1 preterm labor at 22 weeks who delivered successfully after 28 weeks with 1 dying in utero. She has been infused with beta- mimetics and maintained on indomethacin in the Trendelenburg position. | lld:pubmed |
